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Prenatal Drug and Related Exposures in Infant Patients of a Northeast Tennessee Pediatric Primary Care ClinicShoemaker, Griffin, Kwak, Gloria, Jaishankar, Gayatri B., MD, Schetzina, Karen E., MD, MPH 05 April 2018 (has links)
Introduction: The prevalence of opioid abuse has increased throughout Northeast Tennessee. Subsequently, more infants are born drug-exposed or with Neonatal Abstinence Syndrome (NAS). According to the Tennessee Department of Health, hospitalizations for deliveries with maternal substance abuse tripled in Tennessee between 1999 and 2011. During this period, the inpatient hospitalization rate for NAS increased 11-fold. In 2017, there were 163 NAS cases reported in Northeast Tennessee. Depending on intrauterine and environmental exposures, there may be differences in health, growth, behavior, and development in infants. Our goal was to assess and explore those differences to help update education and care recommendations for pediatric primary care clinics.
Methods: This cross-sectional study was set in a Northeast Tennessee pediatric clinic. 120 patients seen for a newborn visit between June 30, 2013 and July 1, 2014 were randomly selected. An additional sample of all infants with suspected drug exposure was identified for this period based on diagnosis codes. In total, 99 infants had no drug exposure and 62 were drug-exposed. An 83-item chart abstraction template was developed. Data was analyzed by SPSS. The chi-squared test and Mann-Whitney U test were used, with a critical value of p<0.05 to determine significance. The Bonferroni correction was applied to account for multiple comparisons. The research protocol was reviewed and approved by the Institutional Review Board of East Tennessee State University.
Results: Of the 120 charts initially selected, 3.33% of infants were exposed to buprenorphine, 1.67% to methadone, 0.83% to marijuana, 0.83% to cocaine, and 1.67% to tobacco, 8.33% to benzodiazepine, and 1.67% to barbiturates during gestation. In total, 18.33% of infants had any drug exposure, 10.00% to any opiate, and 3.33% had a documented diagnosis of NAS in their chart. Prenatal drug exposure was significantly associated with multiple demographic factors as well as pediatric respiratory, behavioral, gastrointestinal, infectious disease, and cardiac conditions.
Conclusions: Prenatal drug exposure was significantly associated with multiple pediatric complications. This illustrates the significance of addressing the increased incidence of prenatal drug exposure in Northeast Tennessee. Future multivariate analyses will attempt to control for potential confounders. This analysis is retrospective and exploratory, and any associations should be confirmed with a prospective study. A weakness of this study includes potential under-diagnosis of drug exposure and NAS due to lack of documentation in the EHR. Additional research will include further comparison of maternal and infant complications in drug-exposed and non-exposed infants. This will allow for a better understanding of the risks associated with maternal drug exposure. Findings from these research projects will be used to inform clinical initiatives for NAS in Northeast Tennessee.
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ReadNPlay My Baby Book Mobile ApplicationSchetzina, Karen E., Jaishankar, Gayatri 01 January 2018 (has links)
No description available.
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Assessing the Knowledge, Attitudes, and Perceptions of Parents and Caregivers Toward Healthy Lifestyles of Children Aged 0-2 years: ReadNPlay for a Bright FutureFalodun, Ayotola, Schetzina, Karen, Olanrewaju, Folawiyo Saidat, Jaishankar, Gayatri 12 April 2019 (has links)
Introduction: Children establish their eating and activity habits in the first several years of life, making this an important time for intervention. ReadNPlay for a Bright Future is a project developed by the East Tennessee State University (ETSU) Department of Pediatrics to support healthy eating, active living, early literacy, and safety for families with young children. In the United States, many infants and toddlers do not meet recommended eating and activity behaviors. The purpose of this study is to assess attitudes, perceptions, intentions, and health behaviors of parents and caregivers regarding healthy family lifestyles in a cross-sectional study.
Methods: Using the Theory of Planned Behavior, a 63-item parent/caregiver survey was developed in Qualtrics to assess attitudes, perceptions, intentions, and behaviors regarding shared reading, screen time, breastfeeding, sugary drinks consumption, fruit and vegetable intake, physical activity, dental caries, injuries, and general health status. Participants were recruited with study fliers distributed in ReadNPlay project clinics, social media sites, and events. Eligible parents/ caregivers are those who have children two years and younger who are patients in the clinics. Parents and caregivers who cannot speak/read English or Spanish and parents/caregivers of children in state custody were excluded from participation. Descriptive analysis of baseline data will be done using SPSS.
Results: Data collection is ongoing.
Conclusion: Data from the surveys will be used to understand how attitudes, subjective norms, and perceived behavioral control influence the intentions of parents/caregivers and behaviors of young children. Survey data will be used to inform improvements in health promotion initiatives for this population.
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ATTITUDES TOWARDS PHYSICAL ACTIVITY PARTICIPATION AND SCHOOL ENGAGEMENT IN ELEMENTARY SCHOOL CHILDRENSteffey, Brianna R, Daugherty, Abigail D, Eveland-Sayers, Brandi M, Ph.D, Chroust, Alyson, Boynewicz, Kara L, Dotterweich, Andrew R. 12 April 2019 (has links)
Numerous benefits are associated with physical activity participation with recent evidence indicating this may transfer into the classroom environment. Purpose: The purpose of this study was to investigate the relationship between attitudes towards active or passive physical activity participation and classroom engagement in elementary school children. Methods: Students (n = 67) in grades 3-5 completed The Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) and The Elementary Student Engagement Instrument (SEI). Results: A statistically significant positive correlation (r = .31, P < .05) was found between the CSAPPA and SEI indicating that students who prefer active participation in physical activity also report higher levels of engagement within the school environment. No statistical difference was noted between males and females or across grade levels. Conclusion: The results of this research support the benefits of physical activity participation within the school environment. The lack of statistical difference with regard to sex is also noteworthy in that research connecting physical activity and classroom engagement frequently indicates differences between males and females. This is possibly attributed to the inclusive culture established by the school which promotes and supports opportunities for all students. These findings are particularly relevant in light of current trends to reduce time spent in physical education, free play, and other physical activity opportunities within the school day.
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PERCEIVED PHYSICAL ABILITY AND SELF-PERCEPTION OF ADEQUACY AND ENJOYMENT FOR PHYSICAL ACTIVITY IN ELEMENTARY STUDENTSDaugherty, Abigail D, Steffey, Brianna R, Eveland-Sayers, Brandi M, Ph.D, Chroust, Alyson, Boynewicz, Kara L, Dotterweich, Andrew R. 12 April 2019 (has links)
How children perceive their physical ability is important in understanding their reported adequacy, preferences, and predilection of physical activity. This relationship is useful in identifying lifelong physical activity behaviors. Purpose: To examine the relationship between perceived physical ability and self-perceptions of adequacy and enjoyment of physical activity in elementary school children. Methods: Students (N = 120) in grades K-5 completed the Perceived Physical Ability Scale (PPAS) and the Children’s Self-Perceptions of Adequacy and Predilection for Physical Activity (CSAPPA). Results: A statistically strong significant positive correlation (r = .49, P < .01) was found between the PPAS and CSAPPA indicating that students with higher perceived physical ability also reported higher scores on the CSAPPA. The high CSAPPA scores are indicative of students having a higher likelihood of choosing physical activity over a non-active option. No significant differences were noted between males and females or across grade levels. Conclusions: Based on these results students who have a greater perception of their physical ability also report being more likely to select a physically active option when given the choice. The findings of this study are noteworthy as previous studies have shown that differences between male and female students may exist with similar measures. These results may be indicative of the environment that has been created at the study site. The study site promotes a culture centered on respect, care, and a growth mindset within its student body. Future research comparing student to teacher ratio, cohesive student groups, and school schedules should be conducted to compare students’ PPAS and CSAPPA results. Programs designed to enhance perceived physical ability and enjoyment of physical activity are needed to promote lifetime physical activity habits.
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Breaking the bttleneck: Understanding the intractable bottlenecks and data-informed decision-making to deliver life-saving commodities for women and childrenNemser, Bennett January 2021 (has links)
Philosophiae Doctor - PhD / Access to life-saving commodities and related services for women and children is a fundamental
component of universal health coverage. However, countries confront numerous intractable
challenges, such as aligning regulatory practices, enhancing health workforce capacity, and effectively
managing supply chains, to ensure essential reproductive, maternal, newborn and child health
(RMNCH) commodities and services reach all communities. To address these entrenched obstacles,
the UN Commission on Life Saving Commodities for Women and Children (UNCoLSC) in 2012
outlined a series of recommendations to improve access to 13 low-cost and high-impact commodities.
This thesis explores the improvements and remaining barriers to accessing life-saving commodities for
women and children in sub-Saharan Africa and Southeast Asia. In addition, this thesis showcases how
effective data-informed decision-making can support prioritized RMNCH investments and equitycentered
action.
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Autonomy-Induced Preference, Budget Reallocation, and Child HealthMandal, Biswajit, Bhattacharjee, Prasun, Banerjee, Souvik 01 December 2018 (has links)
Using traditional health capital model of Grossman (The human capital model of the demand for health. NBER, Working Paper 7078, 1972) and Wagstaff (Bull Econ Res 38(1):93–95,1986a) this paper attempts to fill in the theoretical missing link between mothers’ autonomy and household consumption behavior. We focus specifically on the consumption of child health inputs. In our paper it has been shown that working mothers’ children should be of better health. Further, independent of working status of the mother, higher autonomy always reallocates family budget to induce more consumption of child health inputs. The basic results of our model are further reinforced when autonomy is dependent on mothers’ income. In fact, the income effect derived from our extended model indicates that income-induced autonomy may result in redefining the composite consumption good for the family as an inferior one.
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Clinical Reasoning: A State of the Science ReportHolder, Amy Golden 01 January 2018 (has links)
Clinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.
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Childbirth in Incarceration and Nursing InterventionsMauk, Breanna 14 April 2022 (has links)
Introduction and Background
The number of incarcerated pregnant women is increasing every day. At the same time, their quality of care is decreasing. From being treated like animals by jail staff to having unqualified staff members instructing them during labor, this has to change. Not only is the safety of the woman at risk, but most importantly her unborn baby.
Purpose Statement
Incarcerated pregnant women deserve the same healthcare as anyone else. The PICO question addressed in this paper is the following. In incarcerated pregnant women, how does ineffective health maintenance compared with effective health maintenance affect poor outcomes after childbirth?
Literature Review
CINAHL was used to locate five sources that were published within the last five years. The source had to include the words “childbirth,” “jail,” “prison,” “incarceration,” and “nurse.” If the article did not meet these guidelines they were excluded. One exception to these criteria was one source from 2013. The source was slightly outdated but had valuable data to be explored, so it was included.
Findings
Incarcerated pregnant women are de-humanized and maltreated every day and nothing is changing. Standards of care have been set in place for organizations, but they are not followed. Evaluation of these organizations and their healthcare is crucial to move forward and better health care for people in incarceration.
Conclusions
Insufficient research has caused a gap in literature. Limited resources are available to examine an incarcerated pregnant woman’s life and healthcare. Future research is essential to provided adequate care to these women.
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Case study analysis of the integrated maternal, neonatal And child health strategy in NigeriaEtiaba, Enyinnaya Ifeoma January 2021 (has links)
Magister Artium - MA / Comprehensive policies exist to tackle Nigeria’s poor maternal, neonatal and child
health (MNCH) indices, but departures from policy intent during implementation
result in less than expected outcomes. In Nigeria’s federal system of government,
national level policies are transferred to subnational level, the states as mediators of
for implementation. Executive powers at the state level reside with governors. This
study aims to contribute to a better understanding of the role of states in policy
implementation, taking a historical and comparative view of implementation of three
complex programmes, which had intergovernmental collaborative aspirations. Study
was set in two (subnational) states (Anambra and Ebonyi). In addition, national level
data were collected from Abuja – Federal Capital Territory, where policymaking is
domiciled. A qualitative case study design triangulated information from document
reviews (69) and in-depth interviews (44). Emerson’s integrated collaborative
governance (CG) framework was used to examine the overarching multi-level
governance and how this impacted the policy process.
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